1. Taking average nutritional status of households, severe malnutrition is more prevalent in the eastern states, and in UP, MP and Kerala (See for instance Table 9A for Rural Bihar).
2. The nutritional status of scheduled castes and tribes was substantially lower than the recommended minimum in most states. In particular, the intakes of scheduled casts in Kerala, Maharashtra, Tamil Nadu ,MP and UP and tribes in MP, Gujarat and West Bengal were alarmingly low. (See for instance Table 9B where this comes out clearly). The figures for Karnataka which has a high poverty ratio and for Kerala whose low average in a spite of a supposed high standrs of health, remains a puzzle. Kerala’s very poor agricultural performance and the very high free market retail price(40% higher than the all India price of rice) are possible explanations. Also considering the fact. that the decline in poverty ratio was lowest among SC and ST groups, their nutrition probably has not much improved since 1980-81.
3. 1. The incidence of acute malnutrition is definitely high among children, especially in the age group 0-3 years in almost all states, it being higher in tribal tracts. (See Table 9C and 9D). In a number of states, the percentage of children with adequate caloric protein intakes were much lower than the corresponding percentage for households, Children of Scheduled Castes and Tribes in all cases where data was available, suffer from a high incidence of malnutrition.
   2. ICRISAT data for extremely backward arid zone (for 1976) confirms the incidence of seven malnutrition among children in the age group 1-3 among all classes, with incidence of energy deficiencyhigher among children of landless laboureres and small farmers.1
   3. Others have tried to show the prevalence of malnourished children of Scheduled Castes and Tribes groups to be higher in districts that are less developed (irrigation ratio was found associated associated inversely with malnutrition).2
   4. Table 9E on ‘Summary Nutritional Status by Age in Bihar Villages’ shows that nearly half of the children aged less than 54 months suffered from a nutritional deficiency, the figure being 78% for 6-18 months group. On the average only 53.5% of all households was normal.
4. Although resaerch and scholarly data is not very conclusive, there is field experience of several activists to suggest that there is a gender discrimination in food intake against very young girls, not only in North India (which the research data tends to agree),but elsewhere too. There is general gender discrimination with respect to providing quality of life to all women, either it be health care when sick or education or sharing of drudgery. However, it should be noted that the NNMB data does indicate higher incidence of protein-energy malnutritionamong especially the school children, even though caloric inadequacy is comparatively lower among girls. Table 9F also indicates that during the period 1975-80, both males and females suffered to the extent from caloric inadequacy (calorie intake two standard derivations or more below the average). Infact,Table 9F shows figures slightly less for females.

Table 9A
Summary Nutritional Status of Households in Rural Bihar by Social Class (% Distribution)*

Table 9B
Stage-wise calorie intake (Kcal/cu) 1975-80
Average (Rural) by Social Class

Nutritional Problems in India
The major nutritional problem in India is therefore PCM or protein calorie malnutrition, especially among most vulnerable groups like children, pregnant women, lower income groups and population living in tribal tracts. The term PCM implies the problem of malnutrition is one of primarily calorie or energy intake deficiency, the protein deficiency being secondary, since in Indian conditions, the dietary sources of proteins and calories are the same, an adequate qota of calories will expectedly take care of an adequate proteinin the diet.
The other major nutritional deficiency diseases are Vitamin A deficiency, goitreand iron deficiency anemia. In certain parts of India fluorosis is also a problem due to the presence of excessive amounts of fluoride in drinking water. Pellagra, caused due to niacin or nicotinic acid deficiency is prevalent in populations whose staple diet is maize. Pellagra has also been reported in jowar caters, although there is no niacin defiency in this millet.

Table 9C
Percentage of Malnourished (Gr. III + IV) Children in ICD Projects by Caste Status, 1981*

Table 9D
Percentage of Malnourished (Gr. III + IV) children * (0-36) months of Scheduled Castes and Tribes in Rural/Urban/Tribal ICDS Projects, 1981 (%)

Table 9E
Summary Nutritional Status by Age (% Distribution) in Bihar Villages*

Table 9F
Calorie Inadequacy* Among Adult Males and Females
(Perecent of Population)

Lathyrism is especially prevalent in MP, Bihar, UP, etc. among landless labourers and poor farm workers , who are usually the victims and who often get Khesari Dal as a form of wages. The pulse itself is rich in protein. Harmful effects of this pulse are produced if a diet in 2-4 months contains more than 40 percent of Khesari Dal. The disease manifests itself in the form of paraplegia with most victims crippled for the rest of their lives. Khesari is often used for adulteration of other pulses, which is one more vested interest to ensure its cultivation. Soaking of Khesari in hot water to detoxify it is not feasible because of fuel shortage. Studies of the University of Dhaka have shown that boiling the seeds withwater five times did not detoxify it. The only solution seems to be banits cultivation in MP, Bihar and West Bengal as has been done in other states.
Also in India there are a host of other mineral and vitamin deficiency diseases, other deficiency anemias, like folic acid, vitamin B12 and B6 deficiency anemias, and problems caused by food toxicants like epidemic dropsy(adulteration of usually mustard oil with argemone seed oil), alfatoxicosis (due to consumption of ground nut flour becoming now common for the school children’ diets- that has been contaminated by a paricularly toxic fungal growth in groundnutseeds). An epidemic of Veno-Occlusive disease (VOD) of liver hit Surguja district in Eastern MP in 1973 and again in 1975. VOD is apparently caused contamination of seeds of Crotalaria mana with Gondli millet. Guinea worm infestation of water is also a major problem as also a whole host of problems affecting nutrition that are caused by unclean drinking water, chief of which are diarrhoea and intestinal parasitic infestation (including hookworms) that promote chronic blood loss and in turn aggravate iron deficiency.

Table 9G
Average Intake of Food- stuffs (g/cu/day)* in Different Urban Groups

Table 9H
Average Weights and Heights of Adults (20-25 years) in Different Urban Groups

Many of the above diseases, have secondary and tertiary effects. PCM is known to lower work capacity and productivity and worse alter immune response and mental function.
Endemic goitre, caused by iodine deficiency, results in cretinism, deaf mutism and idiocy for the children of goitre victims. Nutritional anemia among pregnant women accounted for 20% of maternal deaths, high premature births, deathsand prenatal mortalities.2 Vitamin A deficiency apart from causing night blindness of atleast 15,000 children every year.
The economic costs of these nutritional disorders apart from the social and political costs, its tremendous, some of them immediately apparent, many others that would unfold over the years.

Dietary Patterns of the Affluent
As Indian populations, move up in social scale, important changes that appear to take place are:

1. Substitution of ‘coarse’ grains like millets for more ‘prestigious’ cereals like wheat and rice. There is also a progressive increase in use of polished varities of rice. The total substitution of millet by rice or wheat would decrease fibre content in diet by about 50% (See Table 10 on ‘Fibre Content of Indian Foods’).
2. Increase in intake of vegetable oils and ghee with often vanaspati (hydrogenated fat) replacing, vegetable oils.
3. Increase in intake of sugar.
4. General increase in calorie intake not related to sedentary nature of occupations.
5. Increased intake of pulses, vegtables andmilk--thismay be conasidered beneficial.
6. More consumption of market processed and commercialised foods, some of which include junk foods high in calories,fats,salt and sugar--all condusive to heart disease and strokes. The upper five is also the more exposed to international (read Western) dietary tastes and therefore exposed to wider junk food choice.

The affluent group of Indians has had prevalence of economy heart disease (CHD) comparable to the affluent in the first world, with prealence of type II diabetes, there to five times that of similar groups in West. Indian who beome affluent appear to be particularly genetically prone to diabetes and CHD, especially when devoid of dietary discipline. Fat intake (in the form of ghee, vanaspati, edible oils) in Indians is particularly bizarre withe the 5% of population consuming 40% of the available fat. Achaya has shown that practically every Indian diet consists of some fat--as ‘invisible fat’.2 Using more recent information available on total lipids in food materials, especiallly, rice, wheat and other cereals, and the average rural dietary data for 1980,the intake of invisible fat was shown to be 20 to 50 gms a day, averaging 29.0 gms. Large coconut intakes in Kerala and Tamil Nadu led to high levels of invisible fat in these states. Staples (tapioca being included in this category in Kerala) contributed to the bulk of the invisible fat (31-88%; average 68%) and milk and pulses an average of 11.4% and 2.4% respectively. Total fat intakes, both visible and invisible made an average contribution of 14.7% in 10 states of India.

Table 10
Fibre Content of Indian Foods